Differences in Receipt of Immunotherapy Treatment Among Patients With Head and Neck Cancer

Author:

Ramkumar Shreya P.1,Bhardwaj Arun2,Patel Amila2,Seetharaman Krishnamoorthy2,Christman Amanda2,Amondikar Ninad2,Abouelella Dina K.3,Hussaini Adnan S.4,Barnes Justin M.5,Adjei Boakye Eric67,Watts Tammara L.38,Osazuwa-Peters Nosayaba389

Affiliation:

1. currently a medical student at Saint Louis University School of Medicine, St Louis, Missouri

2. Navigating Cancer, Seattle, Washington

3. Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina

4. Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois

5. Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri

6. Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan

7. Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan

8. Duke Cancer Institute, Durham, North Carolina

9. Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina

Abstract

ImportanceThe US Food and Drug Administration approved immune checkpoint inhibitors (immunotherapy) for select cases of head and neck squamous cell carcinoma (HNSCC) in 2016. However, it is unclear whether there are clinical or sociodemographic differences among patients receiving immunotherapy as part of their care. Given the known disparities in head and neck cancer care, we hypothesized that there are differences in receipt of immunotherapy among patients with HNSCC based on clinical and nonclinical characteristics.ObjectiveTo characterize clinical and nonclinical factors associated with receipt of immunotherapy among older patients with HNSCC.Design, Setting, and ParticipantsThis retrospective cohort study included patients 65 years or older diagnosed with HNSCC (n = 4860) in a community oncology care setting. Electronic health records from Navigating Cancer were assessed from January 1, 2017, to April 30, 2022.Main Outcomes and MeasuresMultivariable logistic regression was used to characterize clinical (tumor stage [localized vs advanced] and anatomical subsite [oropharyngeal vs nonoropharyngeal]) and nonclinical (age, smoking history, race and ethnicity, sex, and marital status) factors associated with receipt of immunotherapy.ResultsIn the study cohort of 4860 patients, 3593 (73.9%) were men; 4230 (87.0%) were White and 630 (13.0%) were of other races. A total of 552 patients (11.4%) had received immunotherapy. After adjusting for covariates, in the final model, White patients with HNSCC had 80% increased odds of receiving immunotherapy (adjusted odds ratio [AOR], 1.80 [95% CI, 1.30-2.48]) compared with patients of other races. There were no statistically significant differences in the odds of receiving immunotherapy based on age, sex, or smoking history. Patients with nonoropharyngeal disease were significantly more likely to receive immunotherapy than those with oropharyngeal cancer (AOR, 1.29 [95% CI, 1.05-1.59]), as were those with advanced compared with local disease (AOR, 2.39 [95% CI, 1.71-3.34]).Conclusions and RelevanceThe findings of this cohort study suggest that among older patients with HNSCC, White patients may be more likely to receive immunotherapy as part of their care. Equitable access to immunotherapy and other treatment options will reduce cancer-related health disparities and improve survival of patients with HNSCC.

Publisher

American Medical Association (AMA)

Subject

Otorhinolaryngology,Surgery

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